Provider Demographics
NPI:1316064447
Name:MACKLIN, JENENNE R (LCSW)
Entity type:Individual
Prefix:
First Name:JENENNE
Middle Name:R
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1236
Mailing Address - Country:US
Mailing Address - Phone:626-296-1634
Mailing Address - Fax:
Practice Address - Street 1:330 S OAK KNOLL AVE
Practice Address - Street 2:#210
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3419
Practice Address - Country:US
Practice Address - Phone:626-577-1215
Practice Address - Fax:626-844-6765
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical